PB2354: DIFFUSE LARGE B CELL LYMPHOMA IN 65: DIAGNOSTIC, PROGNOSTIC, PROGRESSIVE AND THERAPEUTIC ASPECTS
Authors: Zaineb Mlayah, Sarra Boukhriss, Adnene Laatiri
Journal: HemaSphere (2023)

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: Diffuse large B cell lymphoma (DLBCL) accounts for 30-40% of non-Hodgkin lymphomas (NHL) worldwide. The response to treatment and the survival of DLBCL patients is highly variable. Many prognosis factors are analyzed to perform scores which are using to select patients with same prognostic eligible to the same treatment. Aims: The objective of our work is to describe the epidemiological, diagnostic, progressive and prognostic characteristics and the evaluation of the RCHOP protocol in the treatment of DLBCL Methods: Our study is retrospective, included patients with DLBCL diagnosed between December 2013 and December 2021 and treated with RCHOP protocol (Annex 1). Results: We collected 65 patients. The median age was 55. The sex ratio was 0.86. Extranodal symptoms were present in 63 % of cases. PS ≥ 2 was found in 21.54 % of patients. Peripheral lymphadenopathy was demonstrated on clinical examination in 49.2 % of patients. Bulky mass was found in 29.23 % of cases. Peripheral lymphadenopathy was demonstrated on clinical examination in 49.2% of patients. A Bulky mass was found in 29.23 % of cases. LDH levels were increased in 52 % of patients. Our patients were classified as localized stage in 55.38 % of cases. Extranodal location was found in 56,92 % of patients. Complete remission (CR) was found in 67,5% et the interim evaluation (IE) and it reached a rate of 80% at the final evaluation (FE). The 3-year overall survival (OS) was 67.5% (Annex 2) and the 3-year event-free survival (EFS) was 72,7 % (Annex 3). LDH level (p=0.029), stage (p=0.001), PS (p=0.001), aaIPI (age-adjusted international prognosis index) (p=0.001), and response to interim evaluation (0.005) influenced in a statistically significant way the OS. Only the stage (p=0.031) and the aaIPI (p=0.027) influenced the EFS in our study. Depending on therapeutic groups, these rates (CR, OS and EFS) were variable. For the first group we noted a CR in 75% and 78,7% at IE and FE respectively. The 3-year OS was 91,7% and the -year EFS was 81%. The second group had the best outcomes: we noted a CR in 62,5% at IE which reached 100% at FE. Also, the 3-year OS and EFS were 87,5% and 86,9% respectively. For the third group we found a CR in 53,8% and 53,3% at IE and FE respectively. This group presented poor outcomes with 37,5% as 3-year OS and 55,6% as 3-year EFS. For the fourth group we noted a CR in 80% at IE and 75% at FE. The 3-year OS and EFS were 66% and 66,7% respectively. For the fifth group we noted a CR in 50% and 83,3% at IE and FE respectively. The 3-year OS was 62% and the 3-year EFS was 71,4%. In our study we analyzed CR, OS and EFS depending on the molecular subtypes of DLBCL (germinative center or activated b cell) but we didn’t find any significant difference. Annex 1: RCHOP regimen used depending to the age and the aaIPI. - Age aaIPI 16 - 60 years old 61 – 74 years old ≥ 75 years old 0 factor 1 st group : 6 RCHOP21 5 th group: 6 R mini-CHOP21 1 factor 2 nd group: 8 R-CHOP21 + 4IR 4 th group: 8 R-CHOP21 + 4IR 2-3 factors 3 rd group: 4 R-CHOP14 + 4 IR + autologous stem cell transplantation Annex 2: Three years overall survival Annex 3: Three years event-free survival Summary/Conclusion: Our results are concordant with those described in the literature in terms of global therapeutic response, OS and EFS. Better results are expected with the new therapies offered depending on the molecular type of LBDGC and based on combining positron emission tomography and computed tomography (PET/CT) especially for the third group which needs more therapeutic trials given their poor outcomes. Keywords: DLBCL